Far from being hobbled by fears of COVID-19, lung cancer patients actually showed less depression and anxiety during the pandemic than their healthy peers, a new study found.
Researchers were surprised by the resilience of lung cancer patients and speculated that the strength patients needed to face their disease may have helped them cope more effectively with COVID-19 fears.
In fact, more than twice as many healthy people in the study met criteria for clinical levels of anxiety and depression during the early months of the pandemic as did those with lung cancer.
“We were astounded at how resilient these lung cancer patients were in coping with the threat of COVID-19, given they were already under very difficult health circumstances,” said Barbara Andersen, co-author of the study and professor of psychology at The Ohio State University.
“That’s not to say lung cancer patients were unfazed by the pandemic – they did show concern. But they seemed better able to handle the stress than similar people without cancer.”
The study, published online this week in the Journal of the National Comprehensive Cancer Network, also included Ohio State psychology students and researchers from Ohio State’s Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.
Before the study, there was reason to believe that lung cancer patients might not have coped so well, Andersen said. Other studies have shown that lung cancer patients are the most emotionally distressed of all cancer patients, with the greatest prevalence of mood and anxiety disorders.
“It would have been easy to assume that COVID would add further stress to these patients,” she said.
Data came from 76 patients with advanced-stage non-small cell lung cancer, which accounts for 85% of all lung cancer cases. They were all participants in the Beating Lung Cancer in Ohio (BLCIO) study, which began before the pandemic started.
All participants completed surveys about their psychological health when they were diagnosed, at least a year before the pandemic. They then completed similar surveys, with added questions concerning COVID-19, between April and July 2020.
These lung cancer patients were compared with a control group of 67 similar people who had not been diagnosed with cancer: older adults from Ohio who were current or former smokers, with comparable education and income levels.
The researchers already knew that lung cancer patients were hit hard psychologically when they were diagnosed: About 40% of them were in the moderately to severely depressed range at that time.
What was pleasantly surprising, though, is that the patients showed lower levels of anxiety and depression during the pandemic than when they were diagnosed, Andersen said.
In addition, they were better off than their peers without cancer when evaluated during the pandemic. About 12% of lung cancer patients had levels of depression high enough to be diagnosed as clinically depressed, compared with 28% of the control group. Similar results were found with anxiety.
Overall, compared to the controls without cancer, the patients showed significantly less stress about COVID, less worry about their family contracting the virus and greater success with social distancing.
The patients did have moderate concern about their lung cancer, which is not surprising, Andersen said. But that concern was of similar magnitude to the concern that the people in the control group had about their overall health.
The results suggest that, for cancer patients, COVID was put into the context of their other health issues.
“For these patients, COVID occurred in the midst of an ongoing life-threatening disease, cancer-related symptoms, and routines already disrupted by receiving treatment. The pandemic was just another challenge to overcome,” Andersen said.
“But for the group without chronic conditions, COVID was an unexpected source of stress and made them worry about their health in a way they weren’t used to.”
Andersen said the results don’t mean that depression and anxiety aren’t an issue for lung cancer patients. Many patients are at risk, and doctors and other clinicians should continue to screen for these problems and refer patients who need it to psychological treatment.
But there’s another message from the results, she said.
“It is a message of strength and resilience, of being able to persevere despite all the challenges. These lung cancer patients showed incredible toughness during COVID and went about what they had to do and continued their treatment, despite their very difficult disease.”
Partial funding for the Beating Lung Cancer in Ohio study was provided by Pelotonia.
Co-authors of the study, all from Ohio State, were Nicole Arrato, Stephen Lo, Clarence Coker, Jonathan Covarrubias and Tessa Blevins, all graduate students in psychology; Sarah Reisinger, program director at the Comprehensive Cancer Center; Carolyn Presley, assistant professor of medical oncology; and Peter Shields, professor of medical oncology and deputy director of the OSUCCC-James.
Journal of the National Comprehensive Cancer Network
Method of Research
Subject of Research
Cancer Treatment During COVID-19: Resilience of Individuals With Advanced Non–Small Cell Lung Cancer Versus Community Controls
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